Provider Demographics
NPI:1134555303
Name:LILLEY, ANGELA MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:LILLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1619
Mailing Address - Country:US
Mailing Address - Phone:510-495-7982
Mailing Address - Fax:
Practice Address - Street 1:815 CROCKER RD STE 3
Practice Address - Street 2:CROCKER BUSINESS PARK
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1072
Practice Address - Country:US
Practice Address - Phone:440-471-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist